Best Practices in School-Based Mental Health/Consultee- OVERVIEW The objective of this chapter is to dluminate best Practice in consultation based on an approach imported into school psychology from public health, Consultation is, of course, a key domain (Consultation and Collaboration) in the National Association of School Paychologists (NASP) 2010 Model for Comprekensse and Interated School Potala! Sees (NASP, 2010). Many of the methods and techniques used by school Psychologists adhering to mental health consultation theory are similar to those practiced by adherents to other models in other consultation chapters in. this caltion of Best Praces. This chapter will emphasize those practices that are particularly characteristic of onsultee-centered corisultation, a modern approach to mental health consultation. These practices have heen derived from theory, a long history of case study, and empirical investigation as well as qualitative research (eg, Hylander, 2000), School-based consultee-centered consultation takes lace when school psychologists enter into conversations With teachers or other professional educators about difficulties or questions the educators have concerning their clients. Clients are typically children who are nor thriving in school or are otherwise causing concern Tsues may be academic or behavioral in nature, In the case of school administrators, cimts may be children, Staff, or parents. These conversations may occur once or several times over the course of several weeks, ‘The Drocess is flexible and mast be adapted to the particular School context. Consultees range from experienced Centered Consultation by School Psychologists Jonathan Sandoval University of California, Davis Professionals who seck the perspective of a school psychologist in thinking through a classroom problern to novice educators struggling with a new role and desiring support and insights from the member of another profession. Many of these conversations will take place rior to a formal referral and the involvement of school. based multdisciplinary teams and often obviate their need, ‘This chapter will describe best practices for conduet- ing these conversations. By adopting these practices the school peychologist should be able to structure and facilitate creative problem solving among school per- sonnel, Historical Sources Mental health consultation began as a part of the early cffort by psychiatrists to move away from traditional Psychotherapeutic approaches to mental health and toward prevention. The fusion of public health and Poychiatry began in the 1940s when mental health ‘esources were overwhelmed by the circumstance of the Great Depression of the 1930s and World War IL It Ddecame necessary to use scarce resources to focus on populations and institutions and on methods to promote motional wellness rather than on individual treatment. A number of primary institutions such as hospitals, churches, and schools became the target for attention ffom mental health professionals coming from outside the system, ‘An carly pioneer in these efforts wus Gerald Caplan, Who chronicled 2 decades of workin his landmark 1970 493Best Practices in School Psychology text, The Theory and Practice of Mental Health Consultation (Caplan, 1970). His book has become a major source of ideas about best practice in consultation. Another key figure, Irving Berlin (1977), began similar work in [bringing outside psychiatric consultation to teachers and school administrators. He too worked extensively with schools as an outside consultant from a mental health center. Caplan, Berlin, and others’ descriptions of their work soon came to the attention of prominent school aychologists such as Judith Alpert (1976), Nadine Lambert (1974), and Joel Meyers (Moyers, Freidman, & Gaughan, 1975), who sought to apply these external mental health experts’ work to school psychologists working in the schools. The major issue facing applica tons to the schools is the difference between coming from the outside as a consultant and working as an employee of the school system (.e., as an inside consultant), Caplan’s seminal work influenced others around the world who also believed his ideas could influence practice in the schools. In Scandinavia, particularly, where school psychologists are explicitly prepared as, consultants to preschools and schools, his ideas were accepted and extended (Lambert, Hylander, & Sandoval, 2004). Over the past 50 years, the field of ‘mental health consultation has continued to evolve. In the years before his death, Caplan commented that it ‘was interesting that his ideas had been most accepted and appreciated by school psychologists (Caplan & ‘Caplan-Moskovich, 2004; Erchul, 2009). Caplan and Caplan (1993) identified four types of mental health consultation: {a} clientwcentered case consultation, (b) consultee-centered case consultation, © program-centered administrative consultation, and @ consultee-centered administrative consultation, Of those, consultee-centered consultation captured the goals of many school psychologists’ consultation activiti school settings. Consultce-centered mental health consultation focuses on the characteristics and ideas of the consultee that are contributing (0 his or her work difficulty and involves litle or no direct assessment of the client. The goal is to assist the consultee in working productively with the dient and fiture clients; that is, the consultee voluntarily enters into the relationship, the consultant hhas no administrative responsibility for the consultec, the consultation is time limited, and the consuktec is free to accept or reject any client interventions generated by the process. Thus, mental health consultation is distinguished fiom supervision, counseling, therapy, ‘education, and collaboration. 494 In contrast, Caplan’sclientcentered cate consultation is more related to school psychologists implementing ecological and behavioral consultation. In client-cen- tered consultation, “[ghhe consultant helps by bringing his specialized knowledge and skills to bear in making an expert assessment of the nature of the client's problem and in recommending how the consultee should deal with the case” (Caplan, 1970, p. 92). ‘The descriptor mental halts in mental health consul. tation and the psychiatric background of its pioneers has led to some misconceptions about this model of consultation. First, because Caplan was psychoanalyically trained, many assumed that Freuelian theory isthe main underpinning for this process. Although Freud's ideas Ihave value in the consultation process, other psychological theories also have an important place in understanding the work problems of a consultee. Current conceptions of consultee-centered consultation emphasize the use of a multitude of behavioral, cognitive, and developmental theories to understand consultees and clients Second, the tetm mental health in the label implies that the consultce is not mentally healthy and that the cconsultee is receiving a psychological treatment. In fact, Gaplan meant that the ultimate outcome of consultation ‘was mental health promotion; that i, to improve mental health and educational ontcomes for future clients of the consultee, Caaplan's public health background led to his hope in making institutions like the school more elective in promoting healthy mental and physical development by asisting key personnel in becoming more succesful vwith their clients. In gpite of these misconceptions and the difference between being an outside consultant and being employed by the consultee’s institution, consultants in the United States, Scandinavia, Europe, and Isracl have continued to develop the practice and theory of consultee-centered consultation (Lambert ct al, 2004) ‘To avoid some of the past misconceptions and t0 capture some new ideas from contemporary practice, many school psychologists following this model have chosen to use the label conslle-centered consutation rather than the mote generic label mma! health consuliation. Definition of Consultee-Centered Consultation As of 2013, four international conferences have been held to discuss continuing developments in consultee- centered consultation since the publication of Caplan's book in 1970. Participants including Caplan developed the following definition in 1999 (Larabest, 2009 National Association of School PsychologistsConsultee-centered consultation emphasizes a nonbicratchical, nonprescriptive helping role rela- tionship between a resource (consultant) and a person or group (consultee) who secks professional help with a work problem involving a third party (alien... ‘This work problem is a topic of concern for the consultee who has a direct responsibility for the leaming, development, or productivity of the client. The primary task of both the consultant and consultee is to choose and reframe knowledge about well-being, development, intrapersonal, interpersonal, and organizational effectiveness appropriate to the consultee’s work setting. ‘The goal of the consultation process is the joint development of a new way of conceptualizing the work problem so that the repertoire of the consultee is expanded and the professional rela- tionship between the consultee and the client is restored or improved. (Lambert, 2004, pp. 11-12) Parameters of Consultee-Gentered Consultation According to Caplan, in consultee-centered consultation the consukant has no administrative responsibility for the consultee’s work and. no professional responsibility for the outcome of the client’s case. The consultant hhas no authority to modify the consultee’s behavior toward the client. Similarly, the consultee has no need to accept the consultant's ideas or suggestions, ‘There is a coordinate relationship between the consultant and consultee and an understanding that together they will discuss the work problem and share respective views of the problem from their own perspectives. The discussion about the client occurs between two professional equals. The consultant, being 2 member of another profession, fosters this coordinate relationship Further, the consultant has no predetermined body of information that isto be imparted to the consultee. The consultant acknowledges that the consultee has relevant expertise about the client's work problem. The consul tant hopes to help the consultee improve the handling or understanding of the current work problem with the goal of assisting the consultee in managing similar problems in the future, The aim i to improve the consultee’s job performance and not necessarily his ‘or her general sense of well-being. Consultee-centered consultation does not involve the discussion of personal Data-Based and Collaborative Decision Making, Ch. 32 Consultee-Centered Consultation or private material, and the consultation process is understood to be a privileged communication on the part of the consultant. The primary responsibility for the ‘ontcome with the client remains with the consultee. NASP Practice Model, Problem-Solving, and Multitiered Services Consultee-centered consultation is one of the models school psychologists should have some familiarity with. Historically, it was one of the first approaches developed when working with a significant adult who influences a chile’s cognitive, socisl, and emotional development. When adults, such as teachers, tum to school psycho! ogists for help with a behavioral, social, or academic work problem, the processes, procedures, and tech- niques generated from this consultation approach will be of use Consultee-centered consultation has at its heart a problem-solving: process in common with other models of consultation and collaboration. Because of the ‘emphasis on problem solving, it has many implications for the school psychologist’s role on teams implementing roultitiered initiatives or generating individual edu- cational plans. One of the outcomes of consultee- centered consultation is new ways of understanding a problem and the development of interventions ¢o address it Since an emphasis on prevention is implicit in the NASP Practice Model (NASP, 2010), consultee-centered consultation also relates to the domain of Preventive and Responsive Services. The intent is for consultees +o ‘expand their repertoire of skills to be able to work more effectively with fature clients, Consultees may include other adults who have influence over children beside teachers, When consulting with school administrators, for example, sysiem level change may result, Finally, consultee-centered consultation is related! to additional domains of the NASP Practice Model in that itis a process for developing interventions to respond to problems in teaching and learning and to facilitate social-emotional functioning and mental health. Consultation may be considered an intervention in its own right or be a delivery system for developing interventions, BASIC CONSIDERATIONS A number of prerequisite skills and background Imowledge are needed prior to implementing best practices im consultee-centered consultation. First, a 495,| Best Practices in Schoo! Psychology school psychologist needs excellent interviewing skills, which include active listening and responding. These skills are typically acquired by taking courses on counseling with adults and children, A second skill set is an appreciation for the role of emotion and unconscious motivation in human affairs. School psychologists should he comfortable with emotionally laden topics and be able to respond in ways that facilitate coping in others. A third set of skills is an ability to apply a number of insights from psychological theories of human development, learning, motivation, and social interaction, School psychologists need a thorough grounding in psychology and the ability to switch theoretical feameworks in thinking about problems. Training in consuitee-centered consultation should include didactic instruction in the underlying theory of consultee-centered consultation exprested by Caplan and others. Training should also include practice in providing consultation in the school setting with supervision from an experienced consultant with opportunities to review cases and to examine the process. Another usefil training experience is to receive consultation (in addition to supervision} during fieldwork from a mental health professional yho is not 2 school psychologist but is trained in consultee-centered consul~ tation (Lambert, Sandoval, & Yandell, 1975), Evidence suggests, however, that training in consultation is not very comprehensive in many school psychology pro- grams (Rosenfield, Levinsohn-Klyap, & Cramer, 2010). Gaplan (1970) has also raised the question of whether a consultee-centered consultant should go through personal psychotherapy. This idea is based on a tadition in psychoanalysis that self-knowledge is necessary for the consultant to be able to identify his or her own psychological issues that may interfere with, the consultation process. Such a requirement is beyond most school psychology training, bat may be useful background experience BEST PRACTICES IN CONSULTEE- CENTERED CONSULTATION ‘As mentioned, many of the best practices in consultee- centered consultation are similar to those in other consultation models. However, there are differences ‘once the definition of consuitee-centered consultation, derived from a mamber of parameters set by Caplan and other pioneers, is studied and is a first source of best practices. Although these early mental health practi tioners consulting in community mental health settings 496 ‘were primarily clinicians, they were disciplined in case- study methods and introduced principles based on long and careful observation. ‘A second way to identify best practices is to examine the stages through which consultce-centered consul- tation proceeds. Most problem-solving consultation models identify five stages: relationship building, problem identification, problem analysis, intervention implementation, and program evaluation. However, after careful consideration of the writings of Berlin, Caplan, and others, we developed additional phases. See ‘Table $2.1. (See also Sandoval & Davis, 1984.) Because the process seldom proceeds linearly, we will use the term fiases instead of sages since stages implies a process that does proceed linearly, Many of these additional phases are elaborations of the baste five, but represent important practices in consultee-centered consultation. Bach phase and the related declarative knowledge and procedural knowledge is listed, This division between declarative and procedural knowledge is between what the school psychology consultant must know and be able to do. Consequently, the best practices spring from procedural knowledge. A third source of best practices originates from research on the process of interaction during consultec- centered consultation that leads to changes or shifty im the consultee’s understanding and behavior toward the client. Research on schook-baged consultation generally hhas been criticized on the grounds that students or beginning consultants are used as the consultant, consultation consists of a relatively brief consultation with a single teacher concerning a single behaviorally defined problem, client outcomes are short term with, litle follow up data, system and other outcomes are iissing, arid the consultant and researcher are often the same person (Hughes, Loyd, & Buss, 2008). To examine the process, qualitative research may provide more evidence about what is effective in naturalistic settings with practicing school psychologists. Working in Sweden, Hylander (2000, 2012) has ‘undertaken such research, She created a grounded theory based on what skilled, effective consultants trained in Caplan’s model actually do in practice. She explicated how three modes of interaction characterize consultce-centered consultation at different times. The skilled use of these modes results in conceptual change it the consultant and the consultee. Hylander describes the ‘approach mode, the fies newrel mode, and the moving 5? modes ‘The approach mode involves the consultant helping the consultee describe the dilemma (presentation), National Association of School PsychologistsConsultee-Centered Consultation Table 32.1. Important Declarative and Procedural Knowledge in Consultee-Centered Consultation Phase Declarative Knowledge Procedural Knowledge Ofientation and relationship ‘= Features of consultation * Establishing proximity building + What consultation is not * Establishing a contract + Using active listening and attending skis ‘Maintaining rapport and + Appropriate selt-disclosure + Communicating openness nonverbally Tesconding to cultural Issues Principles of establishing rapport» Using appropriate, professional + Muticuturel awareness ftiendliness + Consultation ethics * Being direct with respect to cultural Problem exploration + Types of questions Using open and indirect questions + Ciitical listening skills Using reflection + Idea of presentations and representations ‘+ Hylander consultation mode of ‘spproach, free neutral Gathering data ‘+ Measurement techniques across ‘domains, sourees, and methods ‘Sharing information. + Issues of cognitive bias + Need to verify understandings, Problem analysis and reftaming Applying Caplan’s diagnostic taxonomy (lack of skill, knowiedge, self-confidence, objectivity) Using restatement Using summarization ‘Asking what has been tied Saying “I don't know” Avoiding premature suggestions Assigning mutual homework Planning and executing client and system assessment Expressing results and ideas tentatively Looking for confirmatory and dis- confirmatory information Examining one’s own representations Using theme interference reduction Avoiding bind alleys Challenging representations and ‘+ Understanding lack of objectivity faciitating conceptual change ‘= Attribution theory + Cognitive dissonance theory ‘+ Conceptual change theory ‘+ Hylander consultation mode of moving away Generating interventions ‘+ Psychological theory + Applying theory to generate + Educational practice interventions, ‘+ Evidence-based interventions ‘Identifying resources for training + Treatment acceptability ‘Providing accessible reasoning ‘Supporting experiments and ++ Facilitating treatment integrity ‘= Providing ego support Interventions Generating formative evaluation feedback Facilitating treatment validity Evaluating interventions ‘+ Evaluation methods and procedures « Generating summative evaluation Follow up and disengagement Need for feedback relationship Need to retain professional inculeating the experimental altitude Conducting action research Using Informational interviewing skits Facilitating transfer to new clients "Note. Copyright 2012 by Jonathan Sandoval, Used with permission secking to understand underlying thoughts about the ‘causes ofthe problem (representations) and allowing the consultees to discharge feelings and express negative thoughts. In this mode, school psycholo onstrate they can understand and appreciate the point of view of the consulte. Data-Based and Collaborative Decision Making, Ch. 32 The fie neutral mode involves the school psychol- gist and the consultee freely exchanging thoughts and fdeas about the dilemma. ‘The school psychelogist provides structure and focus through asking questions and sharing different perspectives. In this mode, the consultant and the consultee generate hypotheses about 497Best Practices in School Psychology what might be happening and then examine the situation in multiple ways. ‘The moving away mode gets its name from both the consultee and consultant moving away from the old ‘ways of understanding the problem toward new ways of intervening with the client based on a shift in the cconsultee’s (and consultant's) representation, The con- sultant is challenging the old ideas by introducing new information, more satisficiory explanations for beliav- for, and perspectives from psychological theory. The ‘onsultee and the consultant are discovering anew way to frame the dilemma, Hylander’s (2012) is nota stage theory. Ske notes that the process of consultation involves shifting back and forth between the modes, but never directly between the approach mode and moving away mode without going through the free neutral mode. In her grounded theory, she points out how the process may result in change and, how it may fail, either becanse the consultee or the consultant gets stuck in-a blind alley. Hylander’s theory provides many insights into best practices Best Practices Based on Definition and Parameters In what follows, school psychologists’ best practices in consultee-centered consultation are identified along with their sources, Assigning a practice to a specific source is artificial in that most of the best practices may be derived from any of the three sources. Maintaining a Nonhierarchical Relationship ‘The definition of consultee-centered consultation includes the concept of @ nonhicrarchical relationship. Consultants anc consultees view each other as peers, although coming to the relationship with different professional backround and expertise, To maintain the relationship, best practice for a school psychologist is to avoid elevating his or her status on the one hand or to allow the consultee to become deferential or overly modest on the other. One technique, called one- downsmanship, involves purposely being modest about ‘oneself while at ‘the same time acknowledging and complimenting the knowledge and skill of the consultee For example, if the teacher compliments the school psychologist on an idea, the school paychologist might reply that the teacher will know best how to use or modify the idea in the classroom. The school paychol- ‘gist must fistem at all times for flattery or dismissal or other attempts to change the coordinate status of the relationship and be prepared to counter attempts to 498 levate his or her status by pointing out valuable skills and knowledge possessed by the consultee. Besides one-downsmanship, another practice is self disclosure about one’s own shortcomings in doing professional work. This disclosure, aside from Tifing oneself off of a pedestal, if done correctly, can free the cconsultee to examine failure as an opportunity to reflect and learn from the experience. The consultant's self: disclosure should be accompanied by a sober analysis of| what occurred and the lesson Jeamed, modeling positive use of failure. Supporting Consultee Responsibility for the Client In consultee-centered consultation the school psychol- ogist has no direct responsbility for the leaning, development, or productivity of the client, although as employees of the school system they have indirect responsibility. Best practice is to avoid assuming a direct role in working with the client (Le., usurping the teacher's role) and to support the consultee in assuming his or her responsibility in a professional way. The school psychologist might help collect new information by observation or other means, but not by means easily available to the teacher. Consultation is not supervision. Avoiding Personal Issues Consultee-centered consultation focuses oa the work problems of the consultee. As a result, best practice isto he aware of when the focus shifts to personal difficulties or problems the consultee wishes to solve, Best practice is to move the conversation back to the work problem and to gently refuse to enter into a counseling role with the consultee. Consultation is not counseling. Acknowledging Consultee Freedom of Choice ‘School psychologists are not coercive in the consultec- centered consultation role; that is, they cannot impose consultation. Best practice is for the school psychologist to acknowledge and aocept the voluntary nature of the process and to use the existence of a problem a1 ‘motivation to enter into consultation and to use any consuitee frustration in productive ways. The school psychologist must present consultation as a viable method for problem solving and find ways to make consultation convenient and attractive. Because it it volumtary, the consultee is free to accept o reject any suggestions or new ideas that are generated by the consultation process. Further, since only the consultec can decide what action to take folowing consultation, National Association of School Psychologistsissues of intervention acceptability will be important (Frank & Kratochwill, 2008), Having No Predetermined Agenda Except Change Best practice in consultee-centered consultation is to center consultation with no set agenda for how a problem will be solved, School psychologist consultants are Imowledgeable about and committed to a process that will result in a conceptual change but not what that change will be. They hope to contribute insights from psychological theory but have Jin miad no partieular theory in advance. They may offer ideas from beliavioral theory in one case and do behavioral problem solving but in another case may introduce ideas from Vygotsky about the need for social interaction with a skill ntor at the zone of proximal development. Consultee-centered consultation is not prescriptive and does not follow a strict protocol. Facilitating Conceptual Change As the school psychologist and consultee explore the consultation problem, the consultee will likely reveal some thoughts or theories about the client and the causes of the problem, The school psychologist will begin to form ideas or theories (representations) as well. Best practice is to bring those representations out into the open during consultation and examine the repre- sentations for validity and utility in generating interven- tions. As the process proceeds, the school psychologist ‘and consultec will likely explore how the consultee’s construction is inadequate to explain this and other cases. By the presentation of anomalous data—pointing, ‘out where the theory does not work and by highlighting dissonant evidence mot predicted by the consultee's framework—the school psychologist helps build dlssat- isfaction with the current explanatory theory (representa- tion; Sandoval, 1996, 2003). Should this dissatisfaction occur, best practice then is for the school psychologist and consultec to coconstruct a new hypothesis or theory to be tested via intervention. ‘Thc source of the new conception may be the school psychologist or the consultee (or consultees, if it a group consultation). The new theory must be an understandable substitute for the old. It must be intelligible, coherent, and internally consistent and soem Tike a plausible explanation for what is occurring in the ‘lassroom, Finally, the hope is that the new idea will seem to have widespread applicability; that is, it should bbe elegant, parsimonious, and have a high probability of being efficacious in working with the current client and Data-Based and Collaborative Decision Making, Ch. 32 Consultee-Centered Consultation problem as well as with fature clients and problems. It should explain more of che observed facts of the ease than the previous theory, Tn order to test and validate the original conception, the school poychologist tums to. data elicited from the onsultec, discovered in archival records, or newly collected with the consultee’s input and sanction, The school paychologist looks and listens for discrepancies in what has been said or comes from other sources. These iscrepancies produce cognitive dissonance, which is an ‘excellent source of motivation for individuals to change conceptions. The focus will be on anomalies (ie., how existing notions about the problem fail to explain the situation or produce successful interventions). Often analogies and metaphors will be used to introduce the new ideas and conceptualization and ‘make them intelligible to both the school psychologist and consultee. Although analogies may be useful inal, it is important to be sure that the correct features are abstracted from the analogy and transferred to the new theory, For example, one teacher saw a child in a new light afier the school psychologist brought up a character in the movie Litle Miss Suushine. Instead of viewing the child as strange and inattentive, the teacher began to appreciate how driven the child was to succeed in an unusual domain ‘The concept of conceptual change is central con- sultee-centered consultation. It will be discussed again in the section on best practices based on modes of interaction, Best Practices Based on Phases Here will be discussed best practices based on phases rather than based on stages, Remember that because the process seldom proceeds linearly we use the term phases instead of siages since stages implies a process that does proceed linearly. Beginning the Process Carefully A best practice in beginning the process of consultation involves establishing a closeness with consultees. For ‘example, the school psychologist should spend time in the teachers’ lounge or join teachers on yard duty oF ‘other school events but should not engage in gossip. It will take time to establish both trust and eredibilty with consultees. The school psychologist will need to find ways to be seen as reliable and competent. To this end, the school psychologist needs to respond to needs in the school and classroom and be seen as a professional. Best practice isto be useful in as many ways as possible and 499Best Practices in School Psychology available, trusting that in time he or she will be approached with a request for consultation. ‘Another best practice during this phase is establishing 1 clear contract. The school psychologist must be clear about what consultation can do, what the parameters are, and what the responsibilities of each party are. The school psychologist must explain confidentiality and attend to it scrupulously. Exploring Consultee Conceptualizations of the Dilemma Consultee conceptions must be openly examined, and then tested, and then falsified if found to be inadequate. To be tested, however, the conceptions must first be ‘organized in hypothetical form, such as “This is what we ‘think is going on.” Once made explicit, conceptions may be tested. Testing may range from recollections, thought experiments, and actual trials of interventions with the client, For example, after a teacher noted a gitl’s engagement problems during arithmetic. instruction, attributing it to attention deficit disorder, further observation in other settings indicated the child was able to work independently on a demanding social studies assignment. What was found was the gitl had bbeen absent from school because of an extended illness and thus did not have fundamental arithmetic skills. Simply put, a different way of thinking about the gitl’s problems had to be discovered. ‘The information used to test conceptions must be valid and objective, The discussion and testing must be done in a way that is neutral and does not put the consultee or consultant on the defensive, Such a discussion requires great interpersonal ski, Asking Questions to Illuminate Conceptions At the beginning of the process, school psychologists should ask a number of questions to understand the consultee’s representation of the problem and should ask ‘what the consultee has done to adelress the problem and how well it worked, Guvi (2004) has suggested a number of questions 0 help clarify the consultee’s understanding of and theory about the consultation dilemma. ‘To focus on the consultee’s explanations a school psychologist might ask, “Why do you think this i so? Is there something than can help us understand the client? What do you think is going on?” To focus on the consultees picture of the client, the consultant might ask, “What does the client look like?” To focus on the consultee’s fantasies about the future, the consultant ‘might ask, “What do you think will happen if nothing i done?” To focus on other imagined scenarios of 500 importance, the consultant might ask, “Have you met a similar problem before and what was the cause?” Questions such as these are very hefpfil in illuminating the consuliee’s initial theory (or theories) of human bbchavior in general, and specific theory of what is causing the consultation predicament. Most of the school psychologists questions are open ended in nature. Challenging Attributions ‘The consultant should be aware of several errors known to occur in individuals’ explanations of the behavior of others, Attributions may involve internal factors such as ability or external factors such as circumstances. One bias, the fimdamental attribution error, is the tendency to overestimate the internal and underestimate the ‘external factors when explaining the behaviors of others Another bias, the self-serving bias, is the tendency to equate one’s own successes’ to internal factors and failures to external atiributes. Questions to understand attributions are: “What is it about the client's makeup/ abilties/personality that seems to be cansing. this?” “What might be going on in the client's world or environment that might be causing this?” By asking both questions, the school psychologist may open new possbilices Avoiding Some of the Dangers in Using Questions Using the same format of open-ended questions repeatedly or only open questions can result in silted conversation, and consultants should vary question formats. A temptation to be avoided is asking questions to satisfy curiosity rather than to help the consultee 10 explore. Asking too many questions in a short period can be perceived as grilling by the consultee. “Why” questions need to be used carefily, since consultees may view them as accusatory and judgmental rather than a5 simple requests for information, Schoo! psychologists should also avoid asking chetorical questions (les ‘questions to which they know the answer) as this” communicates superiority. : Differentiating the Four Common Reasons for Work Difficulty Caplan (1970) pointed out that consultees come! consultation for one or more of four underlying #es0"8 that the relationship with the client has deteriorated: & work difficulty can come from (a) lack of knowledge). lack of skill, (¢) lack of self-confidence, of (@) lack of professional objectivity, Best practice involves the seh09! National Association of School Psychosispsychologist determining to what extent each source is having an impact on the consultees professional fimctioning with the client. Such a determination is important since each implies a different approach t0 consultation. Table 32.2 lists Caplan’s four sources of consul difficulty, a description, sign of the difficulty during consultation, and the best practice in dealing with i Responding to the Consultee’s Lack of Knowledge Sometimes a consulie’s difficulties of lack of knowl edge are because the consultee has no theory of conception of what is occurring. But some consultees Consultee-Centered Consultation may be a tabula rasa and nced to be helped to gain Imowledge. Whether or not the school psychologist supplies the needed knowledge or refers dhe consultee to other sources depends on many factors having to do with the organizational structure. of the institution in Which the consultee works, The school psychologist in this situation isin the positon of explaining aspects of psychological theory or finding ways for poets or the system t0 provide the needed information about, for example, available curricular resources, The consultant is not teaching the consulte information in his or her professional domain (, pedagogy) but rather pro- viding information from psychology. Since many school psychologists have previously been teachers Table 32.2. Best Practices Based on Caplan’s Category of Consultee Difficulty Consultee Difficulty Description Signs Emerging During Best Practice Consultation Interview Lack of knowledge — Knowledge about psychology (or mental health Lack of ski Consultee understands causes ‘ofthe problem and principles Lndertying intervention but executes poorly Lack of solt Reluctance to engage with or confidence change modes of working with the client Lack of objectivity Direct personal involvement Simple identification Transference Characterological distortions Theme interference Vertal acknowledgment; ertors in descriptions Skill deficts revealed in tho Interview and what has beon done previously wih the cient Anwiety avoidance Cent isthe object for the satisfaction of personal needs Similarity between consultes ‘and client; consultee taking sides Consultee imposes on the ddiemma a pattern of roles from previous fife experiences or fantasies; strong emotion Minor disorders evidenced: consultee has strange affect, Special type of transference; ‘suddenly occurs in otherwise effective professional; theme takes the form af a sylogism: Provide psychological knowledge to the system directly or indirectly; offer group, consultation ‘Avoid assuming supervisory role; facitate exposure to role model Provide peer support through ‘group conéultation; provide onepecitic ego support ‘Support professional identity and ‘thics; replace personal need vith tho satisfaction of professional goal achievement ‘discuss olent's parallel needs; solf-sclosure PProvido a role model by boing ‘emrathotic with all relevant ‘actors in the consultation ddlemma; consider multiple perspectives Realty tosting through careful observation; consider & reversal of roles or cause and offect, ‘Support defenses and lower _anwiety; inorease intellectual Understanding: remain task ‘oriented; provide group consultation Demonstrate that an inevitable ‘outcome is only one possibilty Cardinal error: Remave client from initial eatogory stereotyping ‘Note. Copyright 2012 by Jonathan Sandoval. Used with permission Data-Based and Collaborative Decision Mal 501Best Practices in School Psychology and most have had coursework in education, it may be difficult to resist slipping into the role of supervisor. Nevertheless, the school psychologis’s role in the partnership is to bring psychological theory and knowledge t the conversation so it can be used in the classroom. Responding to the Consultee’s Lack of Skill ‘Best practice in responding to lack of sil in a consultee is to avoid assuming a supervisory role and to locate and encourage the se of models with whom the consultet can identify and who can ilustrate the needed skill, The school psychologist can, however, provide emotional support and encourage practice of the new skill through role playing. Responding to the Consultee’s Lack of Self- Confidence Best practice in addressing a consultee’s lack of self confidence is to provide nonspecific ego support, School paychologists accomplish this by being an empathetic Iistener and responding verbally and nonverbally with calmness and optimism. The school psychologist can probe for mistaken ideas and fears so those ideas and fears may be examined by testing them against reality ‘Sometimes a comment such as “What isthe worst thing that can happen” is helpful. Attending carefully to issues of treatment acceptability is particularly important, In consultation with groups of consultees, pets can also provide encouragement and help the consultee believe an intervention he or she fs considering has a reasonable probability of success. Reducing the Impact of the Consultee’s Lack of Objectivity When a consultee has no conceptualization or has @ naive, but not strongly held, idea about the causes of the problem with a client, the issue is lack of knowledge. However, a consultee may have a conceptualization clouded by personal subjective factors that is emotion- ally charged andl thus leads to the consultee’s being professionally too close or too distant from the client’ situation, As isted in Table $2.2, overlapping categories include direct personal involvement, simple identifica tion, transference, characterological distortions, and theme interference. The table inchudes suggestions for addressing each (see also McCready, 1985). Caplan is best known for his thoughts on theme interference reduction. However, he acknowledged that ‘many consultants, particularly school-based practitioners, hhave not endorsed this technique (Caplan, Caplan, & 502 Erchul, 1998}. A theme is,“A conflict elated to actual life experience or to fantasies that has not been satisfactorily revolved [and that] is apt to persist in a consultee’s preconscious or unconscious as an emotionally toned cognitive constellation” (Caplan & Caplan, 1998, p. 122), Caplan suggesied that in many cases themes, like neatrally toned schema, interfere with effective problem solving but ate even more difficult to address because of the negative affect. He described how themes may be ‘understood as syllogisms the consultee has constructed consisting of an initial category and an inevitable ‘outcome. In consultation, these themes must be shown tobe inadequate betore new ways of working with and of conceptualizing the client will emerge. ‘Theme: interfer- ence techniques include (a) demonstrating that the inevitable outcome is only one logical possibility and that other outcomes are more likely than the dreaded one and (0) avoiding giving nonverbal validation to the theme outcome, These techniques of theme interference reduc- tion are attempts at conceptual change inasmuch as they attempt to influence syllogisins constructed by the consultce. It contributes to prevention by reducing the ‘chance the theme will be applied to funure clients, Instead of offering a different conceptualization, however, the aim of consultee-centered consultation is to elaborate the theme in such a way as to make membership in the initial category imply a number of different outcomes and to complicate the picture, The resulting changed syllogism will suggest that many outcomes are possible and that none ig inevitable. The revised theme will be more plausible and fruitful for working with other clients. One approach is to bring in anomalous data to indicate how the inital category did not lead to the inevitable outcome. ‘As Caplan suggested, the emphasis should be on how the initial theory is inadequate and not on how the theory is inapplicable to the particular client (i.e. by removing the client from the initial category). There will De no motive to change the theory if it is perceived as not applying to the client Distinguishing Themes From Cultural Values Many ideas that a consultee may have about a client ‘may stem from the cultural background of the consutee, which may be different fiom that of the consultant or the client. In the consulice, these ideas may be stereotypes of the client (or the consultant; Ingrahar & Meyers, 2000). Typically, stereotypes lack the strong emotional tome of the theme and may be addressed ore easly. Nevertheless, the school psychologist ust challenge cultural stereotypes when encountered National Association of School PsycholosistéBeing Multiculturally Competent Best practice in consultee-centered consultation involves working cross culturally with consultees and clients coming fom backgrounds different from one’s ‘own, Ingraham (2003, 2004) pointed out that there are threats to consultant and consultce objectivity fiom fitering perceptions through stereotype, from overemphasizing the role of culture, or from being insensitive to cultural norms and values operating in the consultation situation. She also describes interven tion paralysis, a threat to consultee self-confidence, where the consultee is aware of cultural differences but fearful of being inappropriate and considered a racist, Best practices include valuing and soliciting multiple perspectives, creating an emotionally safe environment where culture and race can be discussed, supporting cross-cultural awareness and learning, and seeking cultural guides and teachers. School psycho! ‘ogists must model comfort in discussing cultural issues in consultation, Exploring and Monitoring the Ecological Field ‘The consultation problem exists in a complex field consisting of the classroom, the school, the consultee’s personality, the dient, and the client's family and community, In addition, historical, sociocultural, and psychosocial forces will be at work. The influence ofall of these factors must be taken into account, particularly in generating interventions that will be acceptable, feasible, and capable of being implemented with integrity in the consultee’s unique setting Using Multiple Theories to Understand and Generate Intervention ‘There is little question that behavioral theory has yielded a powerful technology for changing client ‘behavior and that this technology ean used by consultees ‘with the help of consultants, Best practice in consultec- centered consultation is to be open to multiple theoretical ways to understand a classroom situation and to generate ideas that might be helpful in changing the dynamic between the consultee and the client. Developmental theory may be helpful, for example, when a teacher has mistaken expectations for a child, Social psychology may suggest ways to deal with destructive group processes in the classroom, Instructional psychology might suggest ways to modify the curriculum. A school psychologist adhering to consultee-centered consultation must be able to shift from one psychological paradigm to another during the course of consultation. Data-Based and Collaborative Decision Making, Ch. 32 Consultee-Centered Consultation Supplying Ego Support During Intervention Making changes in one’s professional practices, cither modifying old ones or adopting new ones, is not easy and can gencrate anxiety. Caplan and Caplan (1993) ‘observed that consultees are often in a criss state, Best practice is to supply emotional support during the intervention period by supplying accurate feedback, along with optimism about eventual success. School psychologists use data from multiple sources to help the consultee sec progress, even if itis a small amount at ficst. In addition, by remaining calm and unrudiled the consultant communicates confidence in the consultec Inculeating an Experimental Attitude ‘There is usually a hope in consultation that a new solution will emerge quickly and that the client will change overnight. Unfortunately, human problems are seldom easy to solve and change takes place gradually and requires constant monitoring. The consultant must address the expectation of getting it right the first time, ‘The school psychologist rust be positive and reals tically optimistic but help the consultee appreciate a process that is experimental, The consultant mixht say, “This seems like one plausible change you can make in your classroom that will address the problem, but we ‘won't know until we try it?” Hypotheses are generated ‘and tested, and information can be gained from fadure as well as success. Based on data, the consultee must be willing to go back to the beginning and modify plans built on what has been learned, Carefully Evaluating Consultation Outcomes In most forms of consultation, a change in the client is considered the primary goal. In consultee-centered consultation it is also important to cxamine the effect of the consultation process on the whole range of clients who are the responsibility of the consultee. Ifa target bchavior has been identified, then the school psychol- gist and teacher should look for changes over baseline ‘These changes may ako be reflected in institutional data such as absences and test scores, Tn consultee-centered consultation, a key outcome is restoring the relationship between the teacher and the child or between an administrator and the stafl If consultation results in a reestablished positive working relationship and mutual respect between the consultee and clicnt, typically the client's behavior will improve. Improvement in the relationship can be captured by self-report or by an analysis of the consultation process based on the school psychologis’s notes, logs, or other records of the process. There are many dangers in 503Best Practices in School Psychology relying on the self-report of consultee change or of satisfaction with consultation, but they have a place along with other data in the evaluation process Gandoval, 2004). One of the barriers to a positive relationship between a teacher and! a child is anxiety on the part of the consultee. When the anxiety is gone as a result of talking about a case in consultation, the relationship often improves. AS a result, measures of degree of concern about a elient might also be useful Because consultee-centered consultation has a goal of prevention, another outcome that should be reviewed and fostered is the transfer of learning to new clients and settings. ‘Transfer is facilitated by directly examining applications to other clients and situations by asking, for example, “Could this intervention be effective with other children in your classroom?” If the prevention goal of consultation is attsined, measures of the system should show improvement. Following consultation, a teacher might eventually bring fewer cases of the same type to consultation, student performance in academies and decorum will improve, special education referrals will decline, and teachers will show fewer signs of bumout, Working in Groups When Feasible Followers of consultee-centered consultation have been particularly interested in working with groups of teachers where feasible (Babinski & Rogers, 1998; Sandoval, 1977; Wilcox, 1980). Often this has occurred with groups of new teachers, teachers in training, or small groups assigned to a school or a disciplinary department at the secondary level. Best practice involves using group process skill to guide problem solving and develop group cobesion, Am advantage of groups is that ‘members can supply fresh perspective and support for change, as well as make suggestions for intervention based on their experience. Caplan and Caplan (1993) added the concept of ‘mental health collaboration to capture the work school psychologists do when they work as members of jnterdisciplinary teams, Distinctions implied by the term interdisciplinary teams include the shared responsibility for the outcome of the process, the required participation in the team, the lack of feeedom, to reject team decisions, and more direct involvement with the client and, possibly, with parents. As member of the teain, the school psychologist can participate by complicating the thinking of the team and soliciting alternative conceptualization of the problem being addressed (Knotek, Sauer-Lee, & Lowe- Greenlee, 2009) 504 Best Practices Based on Modes of Interaction Hiylander’s (2000, 2012) grounded theory of consults centered consultation also suggests best practices. She argues that school psychologists should be able to move flexibly from a nondirective stance in interactions to a directive stance and back without being prescriptive or coercive, Dealing Skilffully With Emotion An important assumption in a consultee-centered consultation is that consultee emotion is almost always involved in the consultation process. Emotion might spring fom challenges to professional selfeoncept, for instance, or from frustrations in failing to work with a client or from fears for the client’s future. Best practice is for the school psychologist to respond to the consultee in cali, friendly, and deliberate manner. The consultant uses nonverbal means as well as realistic reassurance to communicate that human problems are often difficult to solve. The consultant uses the approach mode, helping the consultee discharge emotion and confirming that he or she can understand the depth and extent of the problem the consultte faces. Willingness to Change Conceptualizations ‘One of the assumptions of consultee-centered consul tation is that the consultee will have a basi idea of what the dilemma is about, Hylander (2012) calls this initiat conceptualization a representation, Other terms for the cconsultee’s understanding might be schema or scenario. ‘The consultee’s articulation of the representation is called the presentation, which may or may not clearly reveal the undealying representation. After listening to the consultee’s presentation and exploring i, the school poychologist will also form an initial representation of the problem. The consultant's representation may oF ‘may not match that of the consultee. Best practice for the consultant is to be open to shifting representations including his or her own, School psychologists must Be able to identify the initial representation of the consultee and to shift from an understanding of the consute’s representation to their own representation to another based on theory and evidence collected during consi tation, School psychologists must also be able to cseate ‘an environment or conversation in which the consultee feels comfortable making a presentation that is acturate and close to their representation (approach). THE representation will have a cognitive component, affective component, and a motivational componeit ‘That is, the representation reflects what the consult a national Asocition of eel PCO ,thinks the problem is, how he or she feels about it, and ‘what he or she is willing todo about it. The consultee’s thoughts, feelings, or willingness to act may not be socially acceptable and cause the presentation to be too vague or t00 stereotyped. When this occurs, the school psychologist will never know the representation unless he or she can ask questions and sharing thoughts in a calm, supportive, and nonjudgmental fashion, Making Reasoning Accessible In consultee-centered consultation, a key skill of the school psychologist is to make explicit to the cansultee his or her own conceptualization of the problem drawn from the information that has emerged from the consultation interview (moving away mode). That is, the school psychologist makes his or her reasoning accessible to the consultee (Monson & Frederickson, 2002) and, more importanly, offers up the conceptual: ization for discussion and debate. One practice that is valuable is following up on a question or observation and then adding the reasoning behind the question. ‘The school psychologist might say, “I am asking that question because T was wondering what behavior is tolerated in his home.” By explicitly talking about one’s ‘own representation one can model the process of sharing, On the other hand, the school psychologist must be willing to challenge his or her own representa tions and return to the neutral position to evaluate them. Examining Turnings Hylander (2012) discussed five kind’ of shifts im under- standings that may occur in consultation, These are distinct turnings, magic turnings, weatheroock tunings, false turnings, and continuous tumings. Best practice consists of distinguishing between them. A. dlstinet turning occurs when the consultee adopts a different explanation for the client's behavior. The school psychologist hopes there will be a distinct change in the understanding the teacher has about the dilemma. However, a distinct turning should be distinguished from a false turning, where there has been no change, and from ‘weathercock turnings, where there are shlis back and forch between old conceptions and new ones. The school psychologist should be aware of and comfortable with the idea that changes in conceptions may take place gradually and that it may be a continuous process. When & conceptual shift is gradual, iti continuous turning. The consultant must also recognize shifts may ocenr without awareness, as if by magic. These magic tumings occur ‘when the consultee makes a spontaneous change in the relationship with the client after simply initiating the Data-dased and Collaborative Decision Making, Ch. 32 Consultee-Centered Consultation consultation process but not completing it. Taking the first step and beginning to talk about the issue can be hicjpfil in and of itself, and lead to new ideas away from the session, or a reduction in the level of anxiety on the part of the consultee that is responded to by the client. Although difficult, the consultant can also monitor the turning or conceptual process by periodically checking the teacher's representation of the problem. This evaluation can be done by asking, “At this point, what do you think is the mast likely explanation for the child's behavior?” Another device is to graphically represent the problem at multiple times during consultation (Sandoval, 2004} SUMMARY ‘School-based consultee-centered consultation is a method of interacting wth a significant adult ina child’ if to help the adult improve his or her work relationship with the child in the present and in the future, It is chiefly distinguished ftom other problem-solving models of consultation in its emphasis addressing emotion and affect as well as exploring underlying ideas the consultee may have about the causes of the problem. It is a voluntary relationship between peers, albeit practitioners coming from diferent professions. It is nonprescriptive in that there is no set agenda or psychological theory to be used. Consultants following this model use practices aimed at problem solving and responding to both the emotional and motivational components of the consultation dilemma. Many consultee-centered consultation best practices are directed at facilitating the process of conceptual change, Most models of consultation hope to being about conceptual change. But in this model the schoo! psychologist does not have a particular change (e4., framing a problem as one of contingency management in mind at the beginning of the process but is confident a new conception will develop spontaneously and organically. In addition, schoo! psychologists following this model should ‘work from the assumption that different approaches are called for depending ifthe problem is a lack of knowledge, Jack of skl, lack of self-confidence, or lack of objectivity School psychologists should also understand that oon sultants can be both nondirective and directive at different times during a complex process. 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